A R A D I O G R A P H E R ’ S P E R S P E C T I V E P A U L A F E E H A N

CT CARDIAC ANGIOGRAPHY

WHAT IS CT CORONARY ANGIOGRAM?

• Non invasive • Low risk • ECG Gated • IV contrast scan of the coronary arteries

CT V ANGIOGRAM

• For patients with chest pain but not having a heart attack

• Radiation may be 50% less than traditional examinations (angiogram and Nuc Med combined) Lima 2012

• Sensitivity 91% • Specificity 92% Budoff 2016 • Highly accurate • Non invasive

PREPARATION

• Cardiac angiography is only possible if the patient is well prepared

• Heart rate less than 60bpm • Green cannula in right cubital fossa • Comfortable clothing • Relaxed and not anxious • Contraindications • Pacemaker

PRE-ASSESSMENT

• Examination explained • Medical history • Heart rate, blood pressure and renal function

checked • Medication prescribed if required • Anxieties addressed • Morning of test advice-no caffeine

ON THE DAY

• Patient arrives • Top changed if necessary • HR checked – oral beta blockers/ivabradine if

required • Cannula fitted

ECG LEADS

• 3-electrode system – Uses 3 electrodes (RA, LA and LL). – Monitor displays the bipolar leads (I, II and III) – To get best results – Place electrodes on the chest wall equidistant from the heart (rather than the specific limbs)

VEINS OF THE FOREARM

IN THE SCAN ROOM

• Patient positioned on the table • Connected to HR monitor • Breath exercise • Cannula flushed with the IV contrast pump • IV beta blockers if required • Slide into start position

IN THE CONTROL ROOM

• Patient name and examination selected on scanner

• Protocol should always be double checked • Cardiac calcium score • GTN given- Nitroglycerin • Plan CT angiogram

CT ANGIOGRAM

• Protocols… • Standard CT angiogram • Graft protocol: • TAVI protocol: gated root then whole aorta • CTA followed by angiogram of the aorta • CTA and portal abdomen and pelvis

AFTERCARE

• Post scan BP and HR obs 15 mins after scan • Hot drink and a biscuit • Information leaflet • Sign off • Remove cannula

HIGH CALCIUM SCORE

RIGHT CORONARY ARTERY

RCA from right coronary Sinus

LEFT ANTERIOR DESCENDING

3D RECONSTRUCTION

Right coronary artery

Left main artery

Left circumflex

Left anterior descending

Ramus intermedius

Aorta

3D VOLUME RENDERING :HEART

RCA

ACUTE MARGINAL BRANCH

DIAGIONAL BRANCH

LAD

ANOMALOUS LEFT CIRCUMFLEX

LCx

RCA

FISTULA

Saccular aneurysm

Pulmonary artery

Fistula

GRAFT-LIMA TO LAD

GRAFT

LEFT CIRCUMFLEX ANEURYSM

Stent

Left circumflex aneurysm with a dissection flap

3D AORTIC ROOT

Left ventricle

Aorta

Mitral valve